The term hallux valgus actually describes what happens to the big toe. Hallux is the medical term for big toe, and valgus is an anatomic term that means the deformity goes in a direction away from the midline of the body. So in hallux valgus the big toe begins to point towards the outside of the foot. As this condition worsens, other changes occur in the foot that increase the problem. One of those changes is that the bone just above the big toe, the first metatarsal, usually develops too much of an angle in the other direction. This condition is called metatarsus primus varus. Metatarsus primus means first metatarsal, and varus is the medical term that means the deformity goes in a direction towards the midline of the body. This creates a situation where the first metatarsal and the big toe now form an angle with the point sticking out at the inside edge of the ball of the foot. The bunion that develops is actually a response to the pressure from the shoe on the point of this angle. At first the bump is made up of irritated, swollen tissue that is constantly caught between the shoe and the bone beneath the skin. As time goes on, the constant pressure may cause the bone to thicken as well, creating an even larger lump to rub against the shoe.
Causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition. Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
Bunions are an often painful condition that may become even more painful as extra bone and a fluid-filled sac grow at the base of your big toe. Some of the most frequently experienced signs and symptoms associated with bunions, besides pain, include redness in your affected area. Blistering over your bunion. Callus formation around your bunion. Bursitis. Nerve damage (numbness and/or sharp pains) in your involved area. Bunions may also cause pain within and below your first metatarsophalangeal, or MTP, joint. Your bunion may become further dislocated and unstable as it progresses and may overload your adjacent joints.
Looking at the problem area on the foot is the best way to discover a bunion. If it has the shape characteristic of a bunion, this is the first hint of a problem. The doctor may also look at the shape of your leg, ankle, and foot while you are standing, and check the range of motion of your toe and joints by asking you to move your toes in different directions A closer examination with weight-bearing X-rays helps your doctor examine the actual bone structure at the joint and see how severe the problem is. A doctor may ask about the types of shoes you wear, sports or activities (e.g., ballet) you participate in, and whether or not you have had a recent injury. This information will help determine your treatment.
Non Surgical Treatment
The choice of treatment for a bunion lies between non-operative (conservative) and operative treatment. Conservative treatment for a bunion means either wearing wider fitting shoes or shoes with softer leather or using some form of a spacer between the big toe and 2nd toe (or alternatively some form of splint to keep the great toe away from the 2nd toe). The spacers or splintage may apparently straighten the bunion but they make no difference to the width of the foot, and the splaying of the 1st and 2nd metatarsals which occur with a bunion deformity. Therefore this type of treatment will not improve the main pain in a bunion which occurs due to the width of the forefoot. An arch type support orthotic may be useful if a bunion is associated with a flatter foot. If you have a bunion this is however just one other thing to get into a shoe with an already wide foot.
A bunion is considered moderate when it pushes against the second toe. In fact, over time, the big toe can force itself under the second toe, causing it to buckle and form a "hammer toe." If non-invasive treatment is not effective, and the joint is still causing discomfort, the doctor may suggest a bunionectomy to realign the big toe. With this procedure, the bunion head is moved over realigning the angled great toe joint back to a normal position. The tendons and ligaments are also balanced for a more normal pull on the toe. In moderate bunion cases, you will experience a relatively rapid recovery. The procedure allows for immediate weight on the foot in a boot and return to tennis shoes in about a month. The choice of procedure best for each patient depends on the deformity size, the stiffness of the 1st metatarsal and the ease of realignment of the 1st metatarsal during the clinical exam.